If you have stress incontinence, one of the two most common types of incontinence, midurethral sling surgery can offer an effective option.
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Women with stress incontinence can experience urine leakage because of any increase in intra-abdominal pressure, including a cough, laugh or sneeze, says gynecologist Katie Propst, MD. For bothersome leakage, it makes sense to consider the surgery.
“Urinary incontinence is a quality-of-life disorder,” Dr. Propst says.
Surgery should be considered at a time when the problem is bothering a woman enough to prevent her from doing things she wants to do ― and when more conservative treatment options don’t work or are unacceptable.
How having a weak urethra causes urine leakage
A weak urethra that can’t withstand normal pressures leads to stress incontinence. Several nonsurgical options are available. Weight loss can help lessen urine leakage considerably. You also can do pelvic floor muscle exercises to strengthen the pelvic floor or use a vaginal support device called a pessary, Dr. Propst says.
When these solutions fail, surgical treatment with a midurethral sling may be recommended. This small piece of mesh material goes under the middle portion of the urethra through an incision inside the vagina and provides support to stop leakage, Dr. Propst explains.
Why sling surgery may be a good option
Among the benefits, slings are less invasive and as effective, or more effective, than the traditional operations for stress incontinence. “Also, complication rates are lower,” Dr. Propst says “But complications related to the mesh can occur. These risks should be discussed with your doctor.”
Understanding the brain-bladder disconnect
Midurethral sling surgery is not offered to treat the problem of urge incontinence, which is another common type of female incontinence.
A kind of breakdown in communication between the brain and bladder can cause urge incontinence rather than an anatomical weakness, Dr. Propst says. “In this case, the bladder often contracts before the brain gives it permission to do so,” she explains. “This causes a sudden urgency to urinate. The end result often is leakage.”
Treatment for urge incontinence can include:
- Exercises to strengthen muscles and reduce urge symptoms
- Peripheral nerve stimulation
- Botulinum toxin injections into the bladder
- Implanting a bladder pacemaker-like device